Value of Thwaites’ Diagnostic Scoring in the Differentiation of Tuberculous Meningitis and Acute Bacterial Meningitis

Flora Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi

Ahmed KEHRİBAR¹  Kadriye KART YAŞAR¹  Filiz PEHLİVANOĞLU¹  Gönül ŞENGÖZ¹  Mehmet BAKAR¹ 

[1] Clinic of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey;

关键词: Acute bacterial meningitis;    Early diagnosis;    Meningitis;    Tuberculous meningitis;    Thwaites’ Diagnostic Scoring;   

DOI  :  

来源: DOAJ

【 摘 要 】

Introduction: Prompt diagnosis and early treatment may greatly affect the prognosis of tuberculous meningitis (TBM). In this study, patients with meningitis followed in the last eight-month period in whom Thwaites’ Diagnostic Scoring was performed were evaluated prospectively. Materials and Methods: Fifteen human immunodeficiency virus-negative patients with meningitis who were followed between February and October 2010 were included in this study. According to the medical history, clinical, cerebrospinal fluid (CSF) and laboratory findings, and results of radiological imaging, patients were considered as acute bacterial meningitis (ABM) (n= 8) or TBM (n= 7). Thwaites Diagnostic Scoring was performed prospectively in both groups. Patients with a total score ≤ 4 were evaluated as TBM. Results: Of all ABM patients, Streptococcus pneumoniae was isolated from the CSF in 4, and CSF leakage was detected in two cases with a history of recurrent purulent meningitis. CSF leukocyte count was over 3000/mm3 in the remaining two cases with ABM. Mycobacterium tuberculosis was isolated from the CSF in 2 patients with TBM. There were multiple intracranial tuberculomas in two patients, multiple intracranial tuberculomas and pulmonary tuberculosis in two patients and therapy response in one patient. The scoring ranged between six and 13 among the eight ABM patients, while it was between -1 and -5 in the TBM patients. Conclusion: Diagnosis is usually difficult in TBM with clinical variations. Since delayed therapy is the most important prognostic factor in TBM, we suggest that Thwaites Diagnostic Scoring can be a useful diagnostic tool for early diagnosis and should be included among the routine investigations for differentiating TBM and ABM.

【 授权许可】

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